<form action="index.php" enctype="multipart/form-data"
       method="post">
    <input name="<?php echo $url_module_param; ?>" type="hidden" value="reportfield" />
    <input name="<?php echo $url_action_param; ?>" type="hidden" value="insert" />
    <table>
        <tr>
            <td>
                Name
            </td>
            <td>
                :
            </td>
            <td>
                <input name="name" type="text" />
            </td>
        </tr>
        <tr>
            <td>
                Formula
            </td> 
            <td>
                :
            </td>
            <td>
                <input name="data" type="text" value="" />
            </td>
        </tr>
        <tr>
            <td>
                Sort
            </td> 
            <td>
                :
            </td>
            <td>
                <input name="sort" type="text" value="" />
            </td>
        </tr>
        <tr>
            <td style="text-align:center;">
                <center><input type="submit" value="Insert" /></center>
            </td>
        </tr>
    </table>
    
</form